Journal Article

A strategic approach to social accountability: Bwalo forums within the reproductive maternal and child health accountability ecosystem in Malawi

Aung, Kyaw Myint, Bedford, Juliet, Johnson, Ginger, Quinley, John, Chiweza, Asiyati, Rogers, Katherine, Butler, Nadia

2020

Overview

Background The majority of documented social accountability initiatives to date have been ‘tactical’ in nature, employing single-tool, mostly community-based approaches. This article provides lessons from a ‘strategic’, multi-tool, multi-level social accountability project: UNICEF’s ‘Social Accountability for Every Woman Every Child’ intervention in Malawi. Methods The project targeted the national, district and community levels. Three Civil Society Organisations (CSOs) were engaged to carry out interventions using various tools to generate evidence and political advocacy at one or more levels. This article focuses on one of the social accountability methods – the bwalo forum (a meeting based on a traditional Malawian method of dialogue). A detailed political economy analysis was conducted by one of the co-authors using qualitative methods including interviews and group discussions. The authors conducted in-country consultations and analysed secondary data provided by the CSOs. Results The political economy analysis highlighted several ways in which CSO partners should modify their work plans to be more compatible with the project context. This included shifting the advocacy and support focus, as well as significantly expanding the bwalo forums. Bwalos were found to be an important platform for allowing citizens to engage with duty bearers at the community and district levels, and enabled a number of reproductive, maternal, newborn, child and adolescent health issues to be resolved at those levels. The project also enabled learning around participant responses as intermediate project outcomes. Conclusions The project utilised various tools to gather data, elevate community voices, and facilitate engagement between citizen and state actors at the community, district and national levels. This provided the scaffolding for numerous issues to be resolved at the community or district levels, or referred to the national level. Bwalo forums were found to be highly effective as a space for inter-level engagement between citizens and state; however, as they were not embedded in existing local structures, their potential for sustainability and scalability was tenuous. A key strength of the project was the political economy analysis, which provided direction for partners to shape their interventions according to local and national realities and be sensitive to the barriers and drivers to positive action.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Accountability / Adolescent / Analysis / Associations / Child / Child Health / Children & youth / Childrens health / Civil society organisations / Clinical decision making / Community meetings / Conferences, meetings and seminars / Decision making / Female / Health Administration / Health Informatics / Health services / Health systems and services in low and middle income settings / Humans / Infant, Newborn / Literature reviews / Malawi / Maternal & child health / Maternal Health / Maternal, newborn and child health / Medicine / Medicine & Public Health / Methods / Newborn babies / Nursing Research / Political economy / Political economy analysis / Political power / Pregnancy / Public Health / Realist evaluation / Reproductive Health / Research Article / Social Responsibility / Strategic social accountability / Teenagers